Migraines: Help for a common problem in children and teenagers

Chocolate, excitement and the stress of Christmas: these are not just a headache for parents. They are also responsible for triggering migraines in many young people. Learning how to manage stress and avoid triggers are just as important as getting the right medication. However the German Institute for Quality and Efficiency in Health Care (IQWiG) today stressed that parents and young people need to be warned about the risks of using migraine medications that have only been approved for adults. The Institute has analysed the latest research on migraines and published information for children and young people on informedhealthonline.org.

Migraines are common in children and teenagers: one in 10 young people battles these thumping headaches now and then. The good news: having migraines when you are a child does not necessarily mean a lifetime of these headaches. Many children will outgrow migraines.

Knowledge can help young people avoid and manage their migraines, according to the German Institute for Quality and Efficiency Health Care. It is important for children and young people to know the difference between the types of headaches, for example. Every headache is not a migraine. "Migraines in young people have the same throbbing pain on the side of the head as in adults, but there are differences as well," said Professor Peter Sawicki, the Director of the Institute. "Children's migraines can be shorter and they are more likely to also have abdominal pain or nausea. Most children will not have auras with flashing lights or wavy vision when they have migraines."

Although researchers have yet to identify the exact causes of migraines, specific factors or foods can trigger migraines in individuals - including chocolate. Stress and poor sleep are other frequent causes. Once a young person knows what is causing their migraines, they might be able to avoid some of the triggers or manage the problem better. "Keeping a migraine diary can show when there are genuine patterns around the headaches and what happens when you avoid - or have - a food you suspect, for example," Professor Sawicki said.

Medication for migraine: different therapy for children and adolescents

Lying down in a quiet dark room with a cold compress on the painful side of the head and trying to sleep it off will often be enough to get through a migraine attack. If more help is needed, the medicines proven to help young people the most without causing many adverse effects are ibuprofen and paracetamol. If they are not enough, a nasal spray of a migraine medication called sumatriptan is available for use from the age of 12.

There is a much wider variety of drugs available for adults, both as treatments and to take regularly to prevent very frequent migraines. However, these have not been approved for use in children and adolescents. "Medications often work differently in children and teenagers than they do in adults, and they can cause unexpected adverse effects in growing bodies," said Professor Sawicki. "This means you cannot just use smaller doses of all adult medications in children. Unfortunately, almost all migraine medications have not been tested in enough trials in children and adolescents to meet the requirements for drug approval."

Children and adolescents are often given adult medication. The Institute stresses that parents and young people need to be warned about the particular risks of what is called "off-label-use". Off-label drug use does not have the same level of scientific, legal and financial protection as approved medicine use.